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General NPI Number Information
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NPI Number | 1649664426
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Entity Type | Organization
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Legal Business Name | ERIC S TRATHEN DPM INC
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 12630 WORLD PLAZA LN 70
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City | FORT MYERS
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State | FL
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Zip | 33907-3987
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Country | US
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Telephone | 239-689-1235
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Fax | 239-274-8319
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Provider Business Mailing Address
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Address Line | 12630 WORLD PLAZA LN 70
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City | FORT MYERS
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State | FL
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Zip | 33907-3987
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Country | US
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Telephone | 239-689-1235
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Fax | 239-274-8319
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. ERIC STEPHEN TRATHEN
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Credential | DPM
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Telephone | 239-689-1235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3472
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License Number State | FL
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